Otgontuya Dugee, Oum Sophal, Buckley Brian S, Bonita Ruth
National Center for Public Health, Ministry of Health, Ulaanbaatar, Mongolia.
BMC Public Health. 2013 Jun 5;13:539. doi: 10.1186/1471-2458-13-539.
Recent research has used cardiovascular risk scores intended to estimate "total cardiovascular disease (CVD) risk" in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted.
This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40-64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated.
The prevalence of WHO/ISH "high CVD risk" (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to "high risk". Of those at "moderate risk" (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication).
Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs.At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.
最近的研究使用心血管风险评分来估计个体的“心血管疾病（CVD）总风险”，以评估人群中的风险分布。该研究表明，与基于单一风险因素水平做出治疗决策相比，采用总风险方法可能会降低低收入和中等收入国家预防性心血管药物治疗的支出。从而突出了与节省相关的患者获益。
本研究使用了2005年至2010年期间在柬埔寨、马来西亚和蒙古对40 - 64岁男性和女性进行的全国性逐步调查（STEPS）数据。该研究使用世界卫生组织/国际高血压学会（WHO/ISH）风险评分图表，比较了在人群层面各种风险估计方法的差异和影响。为了帮助解释和调整评分并为个体治疗提供信息，这些图表还附有关于风险评分计算中未包括的风险因素的实践说明。仅使用图表并根据这些说明进行调整，计算人群中的总风险。还计算了传统单一风险因素的患病率。
仅使用图表时，蒙古、马来西亚和柬埔寨的WHO/ISH“高CVD风险”（10年内发生心血管事件的几率≥20%）患病率分别为6%、2.3%和1.3%，这与最近的研究结果一致。然而，当血压≥160/100 mmHg和/或正在服用高血压药物的个体被归类为“高风险”时，这些比例分别上升至33.3%、20.8%和10.4%。在“中度风险”（10年内发生心血管事件的几率为10 - ＜20%）的人群中，分别有100%、94.3%和30.1%至少受到一种风险增加因素的影响。在所有个体中，分别有44.6%、29.0%和15.0%受高血压这一单一风险因素影响（收缩压≥140 mmHg或舒张压≥90 mmHg或正在服药）。
在人群层面使用心血管风险评分可能会提供有用的见解，有助于卫生服务提供规划。然而，基于总体风险而不调整特定风险因素的方法可能会低估治疗需求。在个体层面，总风险方法具有重要的临床益处。但是，各国需要制定适当的临床指南和操作指南，以便在卫生系统的不同层面使用CVD总风险方法来检测和管理CVD风险。需要进行运筹学研究来评估实施问题。
